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10/11/2013
1
University of Arkansas
System UnitedHealthcare
Group Medicare Advantage
(PPO)
2014 benefit plan
Y0066_130717_100929
Welcome
Why We’re Here
Medicare Basics
Plan Benefits
Questions & Answers
How to Enroll
10/11/2013
2
Why UnitedHealthcare?
UnitedHealthcare is here for you. At UnitedHealthcare, you get help understanding how to get the most from
your plan. You get connected to the care you need, when you need it. And
you get the programs, resources and tools to help you live a healthier life.
Medicare
Basics
10/11/2013
4
Medicare Part B
• Medicare Part B Premium:
• You pay a premium each month for Medicare Part B (Medical Insurance)
• Most people pay the Part B premium of $104.90 each month in 2013
• However, if your modified adjusted gross income as reported on your IRS tax
return from 2 years ago is above a certain amount, you may pay more
• Medicare Part B Late Enrollment Penalty
• If you don't sign up for Part B when you're first eligible or if you drop Part B and
then get it later, you may have to pay a late enrollment penalty for as long as you
have Medicare
• You can sign up between January 1–March 31 each year. Your coverage will
begin July 1
• Your monthly premium for Part B may go up 10% for each full 12-month period
that you could have had Part B, but didn't sign up for it
Medicare Part C (Medicare Advantage Plans)
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Medicare Part D (Prescription Drug Plans)
When are you eligible for Medicare?
You’re eligible for Original Medicare
(Parts A and B) if:
You’re 65 years old, or you’re under
65 and qualify on the basis of
disability or other special situation.
-AND-
You’re a U.S. citizen or a legal
resident who has lived in the
United States for at least five
consecutive years.
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Plan Benefits
Premiums
What you pay today New starting 1-1-2014 SAVINGS
Just you: $ 262.10 (Classic) $ 292.00 (POS)
$ 198.20
$ 63.90 or $ 93.80 per month $ 766.80 or $ 1,125.60 per year
You and spouse are both on Medicare: $ 529.23 (Classic) $ 589.70 (POS)
$ 198.20 x 2 = $ 396.40
$ 132.83 or $ 193.30 per month $ 1,593.96 or $ 2, 319.60 per year
If your spouse is < 65 and not on Medicare…
No change. They stay on the UA plan, same individual rates as current: $ 361.04 (Classic) $ 399.87 (POS)
NA
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Important Enrollment Information
Sample ID Card
Put your Medicare
card in a safe
place
Front Back
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UnitedHealthcare® Group Medicare
Advantage (PPO) plan
All the benefits of Part A (Medicare covered services)
• Hospital stays • Skilled nursing • Home health
The advantages of a single plan. Medicare Advantage (Part C) plans are provided through private insurers,
like UnitedHealthcare. They include Part A, Part B, and Part D — all in
one plan. Medicare Advantage plans also offer additional benefits beyond
doctor and hospital visits.
All the benefits of Part B (Medicare covered services)
• Doctor’s visits • Outpatient care • Screenings and shots • Lab tests
Prescription drug coverage (Medicare Part D drugs)
• Included in the Medicare Advantage plan
Additional benefits (non-Medicare covered services)
• Included in the plan is non-Medicare covered Podiatry , non-Medicare
covered eye exam, Bonus Prescription Drug List
Medicare Advantage (PPO)
We make things simple.
• Hospital costs, doctor and outpatient care in one plan. Benefits are the
same whether you are in or out of the network
• Includes prescription drug coverage
• Vision, hearing and podiatry coverage
• No referral needed to see a specialist
• See any provider anywhere in the United States who accepts Medicare
• The provider does not have to be part of the UnitedHealthcare network
• Providers who have a contract with UnitedHealthcare (in-network) must
accept this plan if you are a current patient
• Providers who do not have a contract with UnitedHealthcare (out-of-network)
have the choice to accept the plan, except in the case of a medical
emergency when they have to accept
10/11/2013
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Member Guide to Care
UnitedHealthcare Group Medicare
Advantage (PPO) plan
You Pay
Deductible (deductible does apply to
annual out of pocket maximum) $500
Annual out-of-pocket maximum
(this does not include prescription drug
benefits)
$1,000
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10
UnitedHealthcare Group Medicare
Advantage (PPO) plan
Benefit Coverage Member Responsibility
Primary care physician
(PCP) office $25 copay
Specialist office visit $40 copay
Urgently needed care (waived if admitted within 24 hrs) $50 copay
Emergency room (waived if admitted within 24 hrs) $65 copay
Inpatient hospitalization / per admit $500 Deductible then $450
copay
Outpatient surgery $500 Deductible then $200
copay
UnitedHealthcare Group Medicare
Advantage (PPO) plan
Benefit Coverage Member Responsibility
Clinical Lab Services $0 copay
Outpatient X-ray Services $0 copay
Diagnostic Procedure/Tests $500 Deductible then 20%
coinsurance
Diagnostic Radiology Services $500 Deductible then 20%
coinsurance
Therapeutic Radiology Services $500 Deductible then 20%
coinsurance
Influenza (Flu), Pneumococcal Pneumonia, Hepatitis B
Vaccines $0 copay
Shingles Vaccine Subject to applicable copay ($25
PCP and/or $70 pharmacy)
10/11/2013
11
UnitedHealthcare Group Medicare
Advantage (PPO) plan
Benefit Coverage Member Responsibility
Non-Medicare routine podiatry $500 Deductible then $40 copay / 6
visits per year
Non-Medicare routine vision $40 copay
Medicare-covered chiropractor $20 copay
Medicare-covered vision services exam $40 copay
Medicare-covered hearing services $40 copay
Diabetic Supplies (blood glucose monitor,
blood glucose test strips, lancet devices and lancets,
and glucose-control solutions for checking the
accuracy of test strips and monitors)
$500 Deductible then 20% coinsurance
Medicare Covered Preventive Care
These services are Covered at 100%, no out of pocket cost to you!
10/11/2013
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Services that apply toward
the annual deductible and out-of-pocket maximum
Member Responsibility Member Responsibility
Annual Deductible Annual Out of pocket Maximum
$500 $1,000
Deductible Yes
ALL PHYSICIAN SERVICES
Primary Care Physician (PCP)/Office Visit (includes Non-MD office visit in a PCP office) Yes
Specialist Office Visit (include Non-MD in specialist office) Yes
INPATIENT SERVICES
Inpatient Hospital Stay - Facility Cost Share for Day Range 1 or Per Admit (Includes Inpatient Substance Abuse)
Yes Yes
Skilled Nursing Facility Care Yes Yes
Inpatient Mental Health in a Psychiatric Hospital - Facility Cost Share Yes Yes
Transplants - Cost Share (For MA Plans - related to Travel and Lodging Only. For Sr. Supp. Plans - Professional services in addition to Inpatient Hospital Services)
Yes
Services that apply toward
the annual deductible and out-of-pocket maximum Member Responsibility Member Responsibility
Annual Deductible Annual Out of pocket Maximum
$500 $1,000
OUTPATIENT SERVICES
Outpatient Surgery Yes Yes
Outpatient Hospital Services Yes Yes
Outpatient Mental Health/Substance Abuse (Individual Visit)
Yes
Outpatient Mental Health/Substance Abuse (Group Visit)
Yes
Partial Hospitalization Yes
Comprehensive Outpatient Rehabilitation Faciity (CORF)
Yes Yes
Occupational Therapy Yes Yes
Physical Therapy and Speech/Language Therapy Yes Yes
Cardiac/Pulmonary Rehabilitiation Services Yes Yes
Kidney Dialysis Yes Yes
MEDICARE-COVERED SERVICES
Chiropractic Visit (Medicare-covered) Yes
Podiatry Visit (Medicare-covered) Yes
Eye Exam, (Medicare-covered)
Yes
Hearing Exam (Medicare-covered) Yes
Dental Services (Medicare-covered Yes
Smoking Cessation Visit (Medicare-covered) Yes
10/11/2013
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Services that apply toward
the annual deductible and out-of-pocket maximum Member Responsibility Member Responsibility
Annual Deductible Annual Out of pocket Maximum
$500 $1,000 AMBULANCE/EMERGENCY ROOM/URGENT CARE
Ambulance Services Yes Emergency Room (includes Worlwide Coverage) Yes
Urgently Needed Care (Contracted Providers) Yes PART B DRUGS Yes Yes Blood Yes DURABLE MEDICAL EQUIPMENT (DME) AND SUPPLIES
Durable Medical Equipment Yes Yes Durable Medical Equipment purchased in a pharmacy
Yes Yes
Orthotics and Prosthetics Yes Yes Medical Supplies Yes Yes Diabetes Monitoring Supplies Yes Yes HOME HEALTHCARE AGENCY Home Health Services Yes Yes Hospice (Medicare-covered) Yes PROCEDURES Diagnostic Procedure/Test Yes Yes Clinical Laboratory Services Yes Outpatient X-ray Services Yes Diagnostic Radiology Services Yes Yes
Therapeutic Radiology Service Yes Yes
Services that apply toward
the annual deductible and out-of-pocket maximum
Member Responsibility Member Responsibility
Annual Deductible Annual Out of pocket
Maximum
$500 $1,000 PREVENTIVE SERVICES Cardiovascular Screenings (Medicare-covered)
Yes
Immunizations Yes Cervical and Vaginal Cancer Screening Yes Prostate Cancer Screening Yes Colorectal Cancer Screenings Yes Bone Mass Measurements (Bone Density) Yes Mammography Yes Diabetes - Self Management Training Yes Medical Nutrition Therapy Yes Annual Wellness Visit (Physical Exam) and One-time Welcome-to-Medicare Exam. (Medicare-covered)
Yes
Annual Routine Physical Exam (Non Medicare-covered)
Yes
ADDITIONAL BENEFITS/PROGRAMS - (Non Medicare-covered)
Routine Podiatry (Non Medicare-covered) Yes
10/11/2013
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Your New Prescription Drug Plan (PDP) • More than 65,000 network pharmacies nationwide — most national drugstore chains and
independent pharmacies are included.
• Thousands of covered brand name and generic drugs.
• Generic drugs as low as $2 through our Pharmacy Saver program2. (Wal-Mart and Sam’s Club
joining the network 1/1/2014)
• www.UnitedPharmacySaver.com
• Bonus drug coverage in addition to Medicare Part D drug coverage.
• Your plan provides full coverage in the Coverage Gap (donut hole).
• Check your plan's drug list or call Customer Service to see if your prescription drugs are
covered.
Your New Prescription Drug Plan
Bonus Drug List (BDL)
• This Bonus Drug List gives you additional coverage on some
prescription drugs that are normally excluded from the Part D formulary
• The list is included in the Pre-Enrollment materials
• Additional covered drugs are not part of the Part D plan and do not
count toward Medicare Part D out-of-pockets costs
• Included in the Bonus Drug List but not limited to: Analgesics,
Antimigraine Agents, Dermatological Agents, Gastrointestinal Agents,
Erectile Dysfunction drugs, Hormone Replacement Drugs, Nutritional
Supplements, Otic Agents, Respiratory Tract Agents
• Drug cost is determined by cost-sharing tier
10/11/2013
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Your New Part D benefit highlights
Tier Prescription
Drug Type Your Costs
Retail (30 day supply) Preferred Mail Order (90 day
supply)
Tier 1 Generic and some
brands $10 copay $20 copay
Tier 2 Preferred Brand and
some generics $35 copay $70 copay
Tier 3 Non-Preferred Brand and
some generics $70 copay $140 copay
Tier 4 Specialty Drugs and
some generics $70 copay $140 copay
Prescription Examples Prescription
What I pay now in the UA plan NEW cost (mail order for 3 months)
Crestor $70 for 1 month $210 for 3 months
$35 for 1 month $70 for 3 months
Nexium $189 for 1 month $ 567 for 3 months (reference based pricing)
$35 for 1 month $70 for 3 months
Diovan HCT $35 for 1 month $105 for 3 months
$35 for 1 month $70 for 3 months
Synthroid $27 for 1 month $81 for 3 months
$35 for 1 month $70 for 3 months
Vesicare $160 for 1 month $480 for 3 months (reference based pricing)
$35 for 1 month $70 for 3 months
Janumet Full cost ~ $77 for 1 month (not
covered in our formulary)
$35 for 1 month $70 for 3 months
Both plans apply the lesser of logic. If a prescription drug is lesser than
the copay amount, you will always pay the lesser amount.
10/11/2013
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More Prescription Examples
Prescription
What I pay now in the UA plan NEW cost (mail order for 3 months)
Lexapro $70 for 1 month $210 for 3 months
$70 for 1 month $140 for 3 months
Premarin $35 for 1 month $105 for 3 months
$35 for 1 month $70 for 3 months
Lisinopril $4 for 1 month $12 for 3 months
$4 for 1 month $8 for 3 months
Zetia $70 for 1 month $210 for 3 months
$35 for 1 month $70 for 3 months
Cymbalta $35 for 1 month $105 for 3 months
$35 for 1 month $70 for 3 months
Both plans apply the lesser of logic. If a prescription drug is lesser than the
copay amount, you will always pay the lesser amount
Mail Service Pharmacy
A pharmacist
reviews your
information for
drug
interactions,
allergies and
dosage.
For your
security,
another
pharmacist
reviews your
medication for
accuracy after
it is dispensed.
OptumRx
seals your
medication in
a tamper-
evident
package.
They mail
your
medication to
you and
notify you
when it has
been
shipped.
Your order
enters
OptumRx
fulfillment
system.
10/11/2013
17
More ways you can save
Review your medications. • Review your prescription drugs with your doctor at least once a year.
Ask, “Do I still need them all? Can I stop taking the ones I don’t need?”
Use your member ID card. • Show your member ID card at the pharmacy to get the plan’s
discounted rates.
Use participating network pharmacies. • You’ll get the greatest benefit, if you use in-network pharmacies.
Take advantage of our Pharmacy Saver Program • Prescriptions as low as $22.
• www.UnitedPharmacySaver.com
Use mail service pharmacy.
• You’ll save time and trips to the pharmacy. 2Drugs and prices may vary between pharmacies and are subject to change during the plan year. Prices are based on quantity fil led
at the pharmacy. Quantities may be limited by pharmacy based on their dispensing policy or by the plan based on Quantity Limit
requirements; if prescription is in excess of a limit, copay amounts may be higher.
Income Related Monthly Adjustment Amount
(IRMAA)
• In January of 2011, the Affordable Care Act established an income related
monthly adjustment amount under the Part D program which is known as
the Part D-IRMAA
• The Part D-IRMAA must be withheld from Social Security, RR Board or
Office of Personnel Management benefit checks unless the monthly
payment isn’t enough to cover the entire amount owed. Otherwise member
will receive a bill from Medicare
• Members will have to pay this extra amount each month, in addition to their
monthly Part D plan premium, to keep Medicare prescription drug coverage
• Social Security will send affected members a letter if they have to pay an
extra amount for their prescription drug coverage. The letter will explain
how they determined the amount the member must pay
• UnitedHealthcare does not determine who will be subject to the Part D-
IRMAA. If a member disagrees with the amount they are required to pay,
they must contact Social Security
• If members do not pay the Part D-IRMAA, they will be disenrolled from the
plan
10/11/2013
18
Income Related Monthly Adjustment Amount
(IRMAA)
Fitness program
Stay physically fit and active at no additional cost.
Join SilverSneakers and enjoy:
• Stay active with SilverSneakers® Fitness Program. Choose a fitness
center from more than 11,000 participating locations. Find the nearest
location at www.silversneakers.com).
• Classes, cardio equipment, resistance machines, free weights and
heated pools (at certain locations). Amenities may vary at
each location.
• Many women-only locations, including Curves®, nationwide.
10/11/2013
19
Fitness program
Don’t live near a fitness center?
If the nearest fitness center is 15 miles or more away from your
home, you can request the SilverSneakers steps program. Once
you enroll in Steps, you may select one of the four kits that best
fits your lifestyle and fitness level – general fitness, strength,
walking or yoga. The Steps wellness tools can help you get fit at
home or on the go.
NurseLineSM
You’re never alone. Whether you have questions about a medication or have a health
concern in the middle of the night, with NurseLine a nurse is only a
phone call away.
Services include:
Nurses answer your health questions 24 hours a day. They
can:
• Help you choose a new doctor
• Provide tips on how to help control diabetes, blood pressure or
high cholesterol
• Review your medication and look for generic options
• Connect you with community resources for exercise
• Provide easy ways you can add fruits and vegetable to your diet
• Provide tips to help stop smoking
10/11/2013
20
Solutions for Caregivers
Helping you care for a loved one.
Solutions for Caregivers supports you, your family and
those you care for.
Services include:
• On-site assessment by a registered nurse
• A personalized care plan
• Connections to local resources
The products and services described above are neither offered nor guaranteed under our contract with the Medicare program.
In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be
subject to the UnitedHealthcare grievance process.
Hearing program
• In addition to your $500 hearing aid benefit you have access to deeply
discounted hearing aids
• Hearing loss is the third most common chronic health condition among older
Americans, and 40% of people age 65 or older are hearing impaired3
• Custom programmed hearing aids can address your personal hearing needs
• Batteries and ear tubes/wax guards, provided at no additional cost, that last most
users six months
• 70-day no-risk trial period
• One-year manufacturer’s warranty
• The convenience of delivery right to your home
• 1-855-523-9355, or www.hiHealthInnovations.com/united
Hearing aids starting at $599 - $799 each,
depending on the model you choose.
3 “Epidemiology of Hearing Loss Study” by the University of Wisconsin School of Medicine and Public Health
The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In
addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject
to the UnitedHealthcare grievance process.
10/11/2013
21
• Welcome Kits are sent to each
of the Retirees Households.
• These Welcome kits contain
the following materials.
• Welcome to Your Plan
Getting Started
• Evidence of Coverage
• Formulary
• Mail Order Rx Form
• Provider Directory
• Pharmacy Directory
• Missing Enrollment Information
Letter
• Confirmation of Enrollment
Confirmation that
UnitedHealthcare has sent the
Retirees enrollment to CMS, and
the enrollment has been accepted
(or) confirmed with CMS. This
letter includes the Retirees ID
card. Required by CMS.
• The Pre-Enrollment booklets
are sent out by
UnitedHealthcare to each of the
Retirees Households.
• These Pre-Enrollment booklets
contain the following materials.
• Pre-booklet Cover Letter
including opt out
information
• Your Plan Explained
• Benefit Highlights
• Summary of Benefits
• Member Rights &
Responsibilities
• The Announcement Letter
is sent out by UAS to
announce the 2013 plan
year benefit changes with
UnitedHealthcare,
Announcement
Letter Sent to
Retirees
Pre-Enrollment Kits
Sent to Retirees
Letters Sent to
Retirees Welcome Kits
September 3, 2013 September 2013 November/December 2013 December 2013
41
Member Mailings and what to expect
General Member Billing Information
•
•
•
•
10/11/2013
22
Understand Medicare’s Rules
• You must keep Medicare Parts A and B and continue to pay your
Medicare Part B premium.
• You can only be in one Medicare Advantage plan at a time. Enrolling
will automatically disenroll you from any other Medicare Advantage or
prescription drug plan.
• Please read your Evidence of Coverage (EOC), including appeals and
grievance rights.
– The EOC also covers specific plan benefits, copays, exclusions, limitations and other terms.
Please review the full text of the Statement of Understanding in your
2014 enrollment kit.
Questions &
Answers